ARTICLES ABOUT ISSUES & TRENDS ON HOSPICE & PALLIATIVE CARE

1.

Guingona pushes for specialized care for sick family members

by Mario Casayuran (Manila Bulletin)
December 26, 2015

Senator Teofisto TG Guingona III sought to make the Filipino culture of caring for the
familyin health, in sickness, and in deatha fundamental element of the Philippine Health
Care system after filing Senate Bill (S.B.) No. 3008, known as the Palliative and Hospice Care
Act.
The measure of Guingona, chairman of the Senate health and demography committee, is
designed to provide a multi-disciplinary care that improves the quality of life of patients and
their families who are confronted with problems associated with life-threatening illness.
Guingona said his bill recognizes the effort and sacrifices of immediate family members
or relatives who must absent themselves from work to look after critically-ill loved ones.
He said his measure allows family members providing palliative and hospice care to use
all existing leave benefits granted by employers, public or private, subject to guidelines on the
use of such benefits.
The practice of palliative and hospice care has been long embedded in the Filipino way
of life. We go out of our way to ease the suffering of family members battling serious health
conditions, kultura natin ito e (It is our culture), he explained.
The bill acknowledges the call of the World Health Assembly to recognize palliative care
as a core component of integrated, people-centered health services, rather than an optional
service.
Under the bill, palliative and hospice care will be included into the structure and
financing of the Philippine Health Care system by strengthening and expanding human
resources, including training of existing health professionals, embedding palliative care into
the core curricula of all new health professionals, and educating volunteers and the public.
Encouraging the development of home-based palliative and hospice care programs at the
grassroots level, which would increase the poors access to quality health service, and
directing PhilHealth to increase its present benefit package to include in-patient palliative
services, outpatient hospice care and home-based palliative care are also included.
Let us give our sick or elderly loved ones the chance to ease into the end of life
comfortably and painlessly, as much as possible. Toward the end of their journey, let us make
them feel that we have done the most that we can for them, Guingona explained.
Dr. Agnes Bausa-Claudio, President of National Hospice and Palliative Care Council of
the Philippines, said that only few palliative and hospice care services exist in the country. She
said she is supporting the bill.
Suffering an unbearable pain, the illnesses cause the patient and many nights of
emotional anguish and psychological distress it causes the family. Also, people at the prime of
their life and career who may have affected by this disease that is progressive and incurable
and prognosis is poor, they suffer all the same, she said.
She thanked Guingona for the recognition he has accorded to the National Hospice and
Palliative Care Council of the Philippines which is a vital partner in moving this legislation
forward to its full realization in the lives of our countrymen.
HAZEL ANNE D. QUIZON

BSN-IIIB

FEB. 9, 2016

For this part, Guingona called for a technical working group to hammer out the inputs of
the Department of Labor and Employment (DOLE) and Government Service Insurance
System (GSIS) regarding the existing and proposed leave benefits for these careers.
Reference:
members/

http://www.mb.com.ph/guingona-pushes-for-specialized-care-for-sick-family-

Patient advocate: This role has been described as the most important of the nursing roles. This
role entails protecting the rights of the patient.
2.

At Lifes End Filipino Care Decisions Rely on God, Family, Home

INQUIRER.net/New America Media , News Feature, Rene Ciria-Cruz, Posted: Sep 25, 2013

SAN FRANCISCO--When it comes to making end-of-life health care decisions, religion,

family and home are powerful influences on many terminally ill Filipino immigrants in America.
This can challenge providers of palliative care, who must deliver comfort care with
sensitivity to seriously ill or dying Filipino patients.
Only God can decide when life ends is why many seriously ill Filipino immigrant
patients and their family members tend to balk at approving advance care directives to
physicians, for example.
Advance-directive completion rates among Filipino patients were a low 10 percent,
according to one study, most probably due to their religious belief that illness is predestined, thus
making the directives pointless.
Id say two out of five Filipino patients Ive seen refused to make a Do not resuscitate
order, said Rowena Patel, the Filipino American nurse manager of San Franciscos Laguna
Honda Hospitals hospice and palliative care unit since 2009.
Fatalism
Many Filipinos have fatalistic views or bahala na (what will happen happens, its Gods
will) when confronted with serious or life-threatening illness.
This is a common finding in the growing body of research in the United States supporting
a culturally competent delivery of palliative care.
Palliative care administered by an interdisciplinary team prevents or manages symptoms
and pain from serious illness is the fastest growing trend in health care in the United States,
where the population of elders is increasing.
Palliative care is meant to improve the patients quality of life, whether or not cure can be
achieved. Hospice care is one of its components.
The studies invariably prescribe a sensitive approach by palliative care providers towards
patients language, culture and traditions in order to ensure their dignity and comfort in what
could be their remaining days.
Hoping for a Miracle
Patel observed that the tendency to eschew palliative care is often based on religious
belief, including divine healing.

HAZEL ANNE D. QUIZON

BSN-IIIB

FEB. 9, 2016

She said that terminally ill Filipino patients she has encountered often asked for really
aggressive care regardless of discomfort, usually hoping for a miracle.
Indeed, a small qualitative 2007 research on elderly female Filipino immigrants in
Vallejo, California, by R. Verder-Aliga, published in the Journal for Filipino Studies, showed that
most of the participants believed that certain illnesses that could not be treated by modern
medicine could be cured through divine intercession.
In a case study cited by Mark T. de la Cruz, MD, and V.J. Periyakoil, MD, of Stanford
University School of Medicine, in Health and Health care of Filipino American Older Adults, a
patient, Mr. Bautista, was diagnosed with terminal pancreatic cancer.
Bautista and his wife found it difficult to shift their hopes from cure to comfort care
because he strongly believed he was just being tested by God, and that miracles could happen.
Prayers and Pilgrimages
Prayers, novenas (devotional acts), even pilgrimages to holy sites, are common weapons
in a Filipino patients arsenal for healing.
Religious beliefs can sometimes roil family dynamics, especially if there are generational
and cultural differences within the family.
The case of Michael Cantos, a 15-year-old Filipino American who had recurrent
metastatic Ewing sarcoma, was cited by Polly Mazanec and Mary Kay Tyler in Cultural
Considerations in End of Life Care, American Journal of Nursing (March 2003).
As Cantos was dying, he became distressed that his maternal grandmother kept praying
the rosary by his bedside, which he didnt think would do him or her any good.
His palliative care providers saw that their challenge was to find a way of mediating
without upsetting him and his grandmother. They had become aware that harmonious family
support is very important to Filipino patients. In careful meetings with Michael and his
grandmother, both alone and together, the palliative teams spiritual-care counselor helped them
accept their differences.
Family Influence
One study found that patients and family caregivers named two important aspects of a
peaceful death--the familys willingness to take care of the patient and belief in God (Romulo
Virola, National Statistical Coordination Board, 2010).
Filipino families, and the premium they place on maintaining group harmony, greatly
influence patients decisions about health care, reported Stanford doctors De la Cruz and
Periyakoil.
When Willie Briones father Gonzalo, 94, was diagnosed leukemia, he called his family
together for counsel.
He wanted to make sure that everybody was with him and supported his preference for
hospice instead of seeking treatment, which he thought would only make him suffer needlessly,
said Briones, a San Francisco resident.
Care providers, therefore, must treat the Filipino family as a unit of care, which is
different from the western mode, cautioned Periyakoil, director of Stanford Universitys
Palliative Care Education and Training Program.

HAZEL ANNE D. QUIZON

BSN-IIIB

FEB. 9, 2016

Salmon Effect
Health care professionals also report the so-called salmon effect, in which immigrant
patients living in California and using the states end-of-life-care resources return to their home
country to die.
Ive had at least two elderly Filipinos that we recommended for hospice disappear on
us, said an Oakland-based physicians assistant who requested anonymity. I found out later that
they died in the Philippines.
Expectations of support from an extended family often spur the decision to spend ones
last days in the Philippines. And there is a traditional value that encourages this option.
A 2003 study by the Asian American Federation of New York found that among all
Asians, Filipinos tend not to view care-giving responsibility as a burden, or depending on other
people for care to be a serious problem.
Patients I know who went home to the Philippines instead of going into hospice went
home because they had limited resources here, said Laguna Honda nurse manager Patel, thats
having few or no family members here, or limited financial means.
HospiceA Tricky Issue
Opting for the hospice care, a component of palliative care, is another decision a
terminally ill patient must make, and for dying Filipino patients--and their family members--it
can be a touchy subject
Asian Americans, including Filipino American older adults, were less likely to enroll in
hospice care. This was the finding of a large study [http://stanford.io/18Sxukw] on the last year
of life of Asian Americans/Pacific Islanders and white Medicare beneficiaries in a major data
base of the National Institute of Cancer.
Hospice care is seen as giving up, explained Patel. One of our patients who could no
longer eat and needed assistance breathing still insisted on being taken to an acute care hospital
instead of hospice, she added.
And in one case, Patel said, when a patient dying of stage-four cancer wanted to be
moved to hospice care, family members got upset.
Many Filipino patients, she reported, accept hospice only when they are totally burned
out by treatment, and just a few days before dying.
Like other Asians, Filipino patients tend to prefer dying at home, where approximately
one-quarter of California deaths in 2004 occurred at home instead of a hospice facility, according
to the Center for Health Statistics.
Patel said her palliative care staffers have received training and continue to train. Many of
the staff members are Filipinos, who tend to become close to their patients and are themselves
often affected by the deaths.
The staff gets additional support, she explained, like support groups for patients and staff,
and confidential discussions with counselors. Dying is tricky, Patel said.
Even my own family would still be worried and uncomfortable about putting my
grandma in palliative care and hospice, she admitted, and that includes me, she added,
laughing.

HAZEL ANNE D. QUIZON

BSN-IIIB

FEB. 9, 2016

Rene Ciria-Cruz wrote this report for Inquirer.net, where he serves as U.S. bureau chief,
through a California Healthcare Foundation Journalism Fellowship, a project of New America
Media in collaboration with the Stanford In-reach for Successful Aging through Education
Program.
Reference:
http://newamericamedia.org/2013/09/at-lifes-end-filipino-care-decisions-rely-ongod-family-home.php

HAZEL ANNE D. QUIZON

BSN-IIIB

FEB. 9, 2016